On Thursday, the Nebraska Workers’ Compensation Court is considering amending NWCC Rule 10 to allow physician assistants or (P.A.), nurse practitioners and neuropsychologists to testify by written report.

The proposed rule change appears to have come in response to the recent Bower v. Eaton  decision where the Nebraska Supreme Court held that P.A.s could not testify by written report in the Nebraska Workers’ Compensation Court.

I wrote in October that I believe the Bower decision harms workers in rural areas whose only access to medical care is often a P.A. The decision also harms workers without health insurance whose only treatment for a work injury might be treating with a P.A. at an urgent care clinic. If an employer denies compensability, the only medical evidence that employee may have would be a report from a P.A.

Most lawyers “fix” P.A. reports by having the supervising doctor sign the report. I’ve had P.A.s take offense at that request. I’ve also had defense lawyers attack medical opinions on hearsay grounds by getting a medical doctor to admit that the P.A. is the one with first-hand knowledge about the injured worker.

Under the Bower decision, lawyers are stuck with two options if a P.A report is the sole source of expert opinion from a treating provider: 1) Call the P.A. live as a witness in the same manner as in a civil trial or 2) retain an examiner.

The prohibition of P.A. testimony by written report can also complicate litigation for employers. Often surgeons will have P.A.s do post-surgical follow up visits. In many instances the P.A. will issue return to work notes for light or alternate duty. But since a P.A. isn’t a recognized expert under NWCC Rule 10, there would be some question over whether a P.A. had the right to issue return to work notes. This could weaken an employer’s case that they were accommodating a work injury.